August 22, 2017

Car Seats and Child Passenger Safety

Fifty years ago, few drivers used child safety devices, yet today car seats are a fixture of child safety standards in the US, with every state now requiring their use for infants and young children, and widespread adoption by parents.
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Car seat use has reduced the risk of death in a car accident for children less than a year old by 71 percent and the risk of death for toddlers (aged 1–4 years) by 54 percent in passenger vehicles.

This case study is part of a series that accompanies The Bridgespan Group article "Audacious Philanthropy: Lessons from 15 World-Changing Initiatives" (Harvard Business Review, Sept/Oct 2017). See below for 15 stories of social movements that defied the odds and learn how philanthropy played a role in achieving their life-changing results.

How did car owners and drivers change their behavior? The campaign for child car seats came on the heels of the safety belt push of the 1950s and '60s, marked by Ralph Nader’s 1965 exposé, Unsafe at Any Speed, which galvanized the public and led to the passage of the National Traffic and Motor Vehicle Safety Act of 1966, requiring seat belts in every new vehicle.

Advocates for child safety—volunteer-led efforts relying on shoestring budgets—built on this heightened traffic safety awareness and evidence that car seat restraints saved lives.

That same decade, an American, Leonard Rivkin, and a Briton, Jean Ames, invented the first car seats designed for child safety, while others began to experiment with child restraint systems and organize around educating parents. In 1965, Seymour Charles, a New Jersey physician, published a short article in the New England Journal of Medicine on “Physicians for Automotive Safety” and became the founding head of a nonprofit by the same name (PAS). In 1970, Dr. Annemarie Shelness of New York joined him, and PAS and its scholarly publications became a go-to source for best practices for child car safety. Policy followed advocacy, and in 1971, the newly formed National Highway Traffic Safety Administration (NHTSA) created an early standard for child seating.

Despite this momentum, children continued to suffer and die unnecessarily in accidents due to three factors: lack of car seat use, ineffective car seat designs, and incorrect car seat installation. Concerned citizens continued to mobilize on these issues. To help increase utilization, NHTSA held the first-ever national child passenger safety conference in Nashville in 1978 to bring together advocates from across the country and propel the movement forward. The first statewide law requiring car seats went into effect in Tennessee the same year, thanks to advocacy efforts led by local pediatrician and PAS member Dr. Bob Sanders. With that, the NHTSA continued to organize and fund efforts to bring together advocates to coordinate and share best practices. By 1982, with the help of local and national grassroots advocacy organizations like SafetyBeltSafe U.S.A., 20 states had passed laws requiring the use of car seats for children. The American Academy of Pediatrics also became increasingly vocal about car seat usage and, with increasing public interest, by 1985 every state had enacted a law requiring the seats.

Car seat technology, meanwhile, began to improve significantly, driven by three main factors: a) widespread and high-profile testing from respected independent organizations such as Consumer Reports and the Insurance Institute for Highway Safety; b) continued improvement in quality standards; and c) massive growth in the market due to increased demand from consumers, fueled in part by the proliferation of state laws mandating their use.

Finally, philanthropy, much of it corporate, helped to improve rates of effective car seat installation in the decades that followed. Johnson & Johnson (J&J) became the founding sponsor of the nonprofit Safe Kids Worldwide to teach parents how to prevent fatal injuries to their children, including properly installing car seats. J&J has given tens of millions to such advocacy groups, as have automakers. (General Motors, for example, has given millions, a significant portion of which came through a court settlement.) Ongoing advocacy and investments have led to improved technology and regulation. For instance, NHTSA mandated the LATCH system beginning in 2002—a reliable, standardized connector built into all cars, which is compatible with all safety seats. Today, 97 percent of infants and 94 percent of children aged 1 to 3 are regularly restrained in car seats, although installation remains a major concern, with a federal study in 2006 finding that 72 percent of seats were misused.

Philanthropy’s Role in Large-Scale Change

Our research shows that breakthrough social initiatives share a set of five practical approaches to large-scale change. In the case of child passenger safety, individual and corporate philanthropy, in particular, played a role across four of them.
  • Build a shared understanding of the problem: Donor-supported nonprofits like Ralph Nader’s Public Interest Research Group and Physicians for Automotive Safety (PAS) helped to build and make the case to the public and government for child safety restraints by revealing the depth of the problem and its root causes.
  • Design for massive scale at the outset: At the core of the story is reliance on regulation to scale mandatory usage of car seats. Laws and regulations spelled out the requirements for parents and entrenched car seats as a norm. The involvement of the private market was also important in driving technological improvements to car seats. And, as the movement matured, installation training and car seat donations—with significant financial support from Ford, GM, Toyota, and others—became critical.
  • Drive demand, don’t assume it: Even once car seats were mandatory and effective, child safety advocates continued to push for more aggressive enforcement of the laws and more awareness among parents. Car makers including GM, Ford, Toyota, Mitsubishi, Honda, Nissan, and others gave millions in philanthropy (and legal settlements) to promote car seat safety and advocacy. And, to help serve this demand at scale, groups like Safe Kids Worldwide, which started with a $1 million grant from Johnson & Johnson, led efforts to host car seat installation and inspection events at community hubs like hospitals and firehouses all across the country.
  • Embrace course correction: Shifts in strategy—for example, toward a deeper focus on proper installation of car seats—have stemmed from research funded by both government and philanthropy. Despite incredible success over the past four decades, movement leaders continue to refine their strategy to improve child passenger safety.

Researched and written by Consultant Phil Dearing of The Bridgespan Group, based on Bridgespan interviews with Joe Colella, owner of Traffic Safety Projects; Denise Donaldson, publisher and editor of Safe Ride News; Deborah Stewart, founder of Action for Child Transportation Safety; and Stephanie Tombrello, executive director of SafetyBeltSafe U.S.A., as well as selected sources.


Selected Sources

Associated Press. “Auto Restraints Cut Child Deaths, Study Says.” The New York Times, November 11, 1984.
Breu, Giovanna. “Dr. Bob Sanders Prescribes Car Seats to Save Kids in Crashes.” People, September 14, 1981.
Centers for Disease Control and Prevention. “Child Passenger Safety: Get the Facts.”
Insurance Institute for Highway Safety, Highway Loss Data Institute. “Fatality Facts: Child Safety.”
Kahane, Charles J. “An Evaluation of Child Passenger Safety: The Effectiveness And Benefits of Safety Seats.” NHTSA Report Number DOT HS 806 890, February 1986.
Murfreesboro Post. “Doctor Seatbelt’s Landmark Act Remembered.”
Peterson, Iver. “Results Praised in States Requiring Auto Safety Devices for Children.” The New York Times, November 28, 1982.
Stewart, Deborah D. “More than Forty Years of Progress for Child Passenger Protection: A Chronicle of Child Passenger Safety Advances in the USA, 1965-2009.” Safe Ride News, February 2009. “Everything You’ve Ever Wanted to Know About Car Seats.”

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